clinical meeting

1. Dr. KANTA HALDER
Resident (MD;Phase A)
BICH

2. Particulars of the patient
 Name: Shahriar
 Age: 2 years 6 months
 Sex: Male
 Informant: Mother
 Address: keranigonj
 Date of Admission: 07.06.2015
 Date of Examination: 11.06.2015

4. Chief Complaints
 Bending of neck to the left side since 6
months of age
 Cough for 10 days
 Respiratory distress for same duration

5. History of present illness:
According to the statement of informant
mother, Shahriar was reasonably well upto his
6 months of age. Then the mother noticed that
her child ketp his neck bending to the left side.
Now he also developed cough for last 10 days
which was dry and non-productive and
respiratory distress for same duration. He had
h/o contact with TB patient but no h/o foreign
body aspiration.
With these complaints, he was admitted to
Dhaka Shishu Hospital for further evaluation
and better management.

6. History of Past illness:
Shahriar had h/o repeated attack of RTI since his 1
month of age which was usually subsided within
2-3 days with oral medication.

7. Birth History:
He was delivered by LUCS at term due to
maternal oligohydramnios without any postnatal
complication.
Feeding History:
He is on family diet.
Immunization History:
he is immunized as per EPI schedule.

8. Familly History :
He is the 2rd issue of his non-consanguinous
parents. His grandfather was suffering from
pulmonary TB and completed anti-TB
treatment.
Socio-economic History :
He came from a low socio-economic
background.

9. Treatment History
After admission, he was getting nebulization
and other injectable medications.
Developmental History
He is developmentaly age appropriate.

10. General Examination :
Appearance: Well, alert
Anaemia:
Jaundice:
Cyanosis:
Clubbing: Absent
Oedema:
Dehydration:

11. Cont..
Skin: BCG mark present
Spine: Normal
Lymphnode: Not palpable
Signs of meningeal irritation: Absent
Neck Vein: Not engorged
Ear:
Nose: Normal
Throat:

12. Cont..
Vital Signs:
Heart Rate: 110/min
Respiratory Rate: 28/min
Temperature: 98°F
Blood Pressure: 90/50 mmHg

13. Anthropometry:
Cont..
Weight: 10.5 kg
Height: 71.5 cm
MUAC: 14.5 cm
HAZ: -4.08 (severely stunted)
WHZ: 2.0 (normal)

14. Systemic Examination
Respiratory system :
Inspection :
Respiratory rate: 28/min
Shape of the chest : Flat on left side
Movement of the chest : Restricted in left side

15. Cont..
Palpation :
Trachea is shifted to the left side.
Chest expansibility is reduced in left side.
Vocal fremitus is reduced in left side in mid-
clavicular, midaxillary and post-scapular line,
normal in right side.
Apex beat lies in left 5th intercostal space,
lateral to the midclavicular line

16. Cont..
Percussion :
Percussion note is dull over left lung field in
midclavicular, midaxillary and post-scapular
line, normal in right lung field.

17. Cont..
Auscultation :
Breath sound is vesicular, but diminished in
left lung in midclavicular , midaxillary and
post-scapular line, vesicular in right lung field.
Vocal resonance is reduced in left lung field,
normal in right lung field.
There is no added sound.

18. Cont..
Cardiovascular system :
1st & 2nd heart sounds are audible in all 4
areas.
There is no added sound.
Alimentary system :
No organomegaly.
No ascitis.
Other Systemic examination: No abnormality

19. Salient feature
Shahriar, 2 years 6 months old immunized boy,
1st issue of his non- consanguineous parents,
was admitted with the complaints of bending
of neck to left side since 6 months of age, dry,
non-productive cough and respiratory distress
for last 10 days. Shahriar had h/o repeated
attack of RTI since his 1 month of age which
usually subsided within 2-3 days with oral
medication. He had h/o contact with TB
patient as his grandfather was suffering from

20. Cont..
pulmonary TB and completed treatment.He
had no h/o foreign body aspiration. Shahriar
was well, alert, afebrile. Vitals are within
normal limit. Chest movement was restricted
in left side. Trachea was shifted to the left
side, chest expansibility and vocal fremitus
was reduced in left side. Percussion note was
dull and breath and vocal resonance was
diminished on left side. Other systemic
examination revealed no abnormality.

21. Provisional Diagnosis:
Left sided collapse due to tuberculosis

22. Differential Diagnosis:
 Left sided collapse due to pneumonia
 Left sided collapse due to foreign body
aspiration

23. Investigations
Complete Blood Count :
• Hb: 10.5 gm/dl
• WBC: Total count: 12,700/cumm
Differential count:
o Neutrophil: 48%
o Lymphocyte: 47%
o Monocyte: 03%
o Eosinophil: 02%
o Basophil : 00%

24. Cont..
o RBC:Normocytic normochromic
o WBC:Mature with above
distribution
o Platelet: Adequate
• Platelet : 318,000/cumm
• PBF:

25. Cont..
Blood grouping & cross matching : A positive
Mantoux test : 00 mm
Chest X-ray:

27. Cont..
USG of chest : No free fluid is noted in left
costophrenic angle. Opacity in chest X-ray was
due to consolidation.
CT scan of chest :

30. Final Diagnosis:
Left lung agenesis

31. Management
• Counseling
• Supportive treatment :
Maintenance of nutrition
• Follow up

32. Thank You